Individual
DR. PETA-GAY JACKSON-BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2200 KERNAN DRIVE, BALTIMORE, MD 21207
(410) 448-6283
(410) 448-6277
Mailing address
2200 KERNAN DRIVE, BALTIMORE, MD 21207
(410) 448-6283
(410) 448-6277
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0052122
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110229896
—
MD
Enumeration date
06/16/2006
Last updated
09/02/2009
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